Stroke

Question 1

What are the types of stroke?

Answer 1

Total anterior circulation
Partial anterior circulation
Lacunar
Posterior circulation
Pontine
Cerebellar

Question 2

What causes a TACS?

Answer 2

25% haemorrhagic

75% ischaemic- cardiac embolus or MCA or ACA occlusion

Question 3

What are the clinical features of TACS?

Answer 3

All 3 of

• hemiplegia/hemisensory loss
• Homonymous hemianopia
• Higher dysfunction

Question 4

What higher dysfunction can be seen in TACS?

Answer 4

Left sided= dysphasia
Right sided= agnosia
Visuospatial disturbances, decreased level of conciousness

Question 5

What are the features of a PACS?

Answer 5

2/3 of

• motor and sentry deficits
• higher dysfunction
• homonymous hemianopia

Question 6

What causes a lacunar stroke?

Answer 6

Small end artery infarction affecting internal capsule and basal ganglia

Question 7

What are the types of lacunar stroke?

Answer 7

Pure motor
Pure sensory
Sensory motor
Ataxic hemiparesis

Question 8

What are the features of a LACS?

Answer 8

Isolated motor and/or sensory deficits with no cortical deficits

• hemiparesis and numbness, ataxic hemiparesis
• no hemianopia, dysphasia, inattention or brainstem signs

Question 9

What are the features of a POCS?

Answer 9

Involves vertebrobasiliar arteries
Ipsilateral CN III-XII and contralateral motor or sensory loss
Eye movement disorder, Hemianopia, double vision
Cerebellar/brainstem dysfunction

Question 10

What vessel is affected in a pontine stroke?

Answer 10

Basilar artery

Question 11

What are the features of a pontine stroke?

Answer 11

Mainly motor and oculomotor signs- contralateral hemiparesis and numbness
N&V, vertigo
Reduced responsiveness

Question 12

What are the features of a cerebellar stroke?

Answer 12

DANISH
Dysdiadokinesia (can't perform fast movements)
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia

Question 13

What investigations are done for a stroke?

Answer 13

FBC, U&Es, ESR, glucose, platelets
Coagulation screen, INR
CT

Question 14

What bloods are done in a stroke in <55yo?

Answer 14

Autoimmune and thrombophilia screen

Question 15

What is the emergent management of an ischaemic stroke?

Answer 15

Thrombolysis and thrombectomy in 4.5 hours
Thrombectomy within 6 hours (or 24 if salvageable brain tissue)
Aspirin 300mg within 48 hours

Question 16

What is the emergent management of a massive haemorrhage stroke?

Answer 16

Surgery

Question 17

What is the secondary prevention post stroke?

Answer 17

Aspirin 300mg daily for 2 weeks then clopidogrel 75mg long term
Atorvostatin 80mg
?carotid endarterectomy

Question 18

What is a red flag for cerebellar stroke?

Answer 18

Vertical nystagmus